Traumatic events occur every day, somewhere in the world. They are inevitable. Sometimes we are directly affected by them and other times, exposure to these events occur by means of social media, news, internet, or hearing about them in other ways.
What is Trauma?
The DSM–5-TR (APA, 2022) (the manual that is used to diagnosis mental health issues) defines trauma as exposure to actual or threatened death, serious injury, or sexual violence in 1 or more ways, such as direct experience, witnessing, learning or repeated or extreme exposure to details.
For example, perhaps you have a child who attends school. Your child has never been in a school environment where a shooting occurred. But, you have heard about multiple school shootings through the news, and now worry and feel panicked each morning as you take your child to school. You have an intense fear for their safety. Perhaps you have dreams or nightmares about safety, threat or violence. Although you nor your child have not been directly exposed to the trauma (the school shooting), you feel symptoms of a post trauma response; you have been negatively impacted after learning about it.
Trauma impacts ability to think, feel, behave, and connect with other according to a situation instead of a perceived threat. The brain/body responds to trauma with survival states, and stays on the lookout for threats. (Van der Kolk, 2015) (Ho, Chan, Luk, Tang, 2021).
If trauma occurs in childhood, this can have detrimental consequences on a child’s ability to think, learn, behave, interact with other or hit age appropriate developmental or growth milestones.
Trauma affects the area of the brain, the Amygdala, by activating the fight/flight mechanism of the brain. This part of the brain is “wired” to keep us alive and safe. We want this response to occur when we are actually in threating situations. Why? When the amygdala is activated, there is an increase of cortisol (stress hormone) released that gives us energy, strength and an ability to fight back, defend, run away or freeze (play possum) to stay alive. Cortisol increases the ability to respond quickly. After the fearful or threatening event has stopped, the brain should begin to decrease cortisol, calming down the nervous system and returning to a more balanced state. However, if the brain does not return to a calmer state, and the release of cortisol continues over a period of time, it can affect levels of other chemicals and hormones, such as serotonin, causing a depressive or anxious reaction.
Symptoms of Depression, Anxiety, and ADHD:
Depressive symptoms may include:
- decreased energy
- low motivation
- difficulty concentrating
- sleep disturbance
- difficulty getting out of bed
- loss of interest in activities you used to enjoy
- emotional and physical fatigue
- tearfulness
- difficulty engaging socially and/or intentional avoidance of social interactions
Anxious symptoms also affect mood, affect, function:
- worry
- fear
- sleep disturbance
- avoidance
- panic
- difficulty concentrating or issues with memory
ADHD also carries symptoms of:
- difficulty focusing
- concentrating
- impulsiveness
- sleep disturbance
- behavioral issues
- difficulty being still or calm
Post Traumatic Stress Disorder also involves many of these symptoms. In my work, I often see patients that present with a mixed bag of symptoms, which have been diagnosed with GAD (Generalized Anxiety Disorder), MDD (Major Depressive Disorder), and/or ADHD (Attention Deficit Hyperactivity Disorder). Sometimes, as we dig a little deeper into their history (what they have been exposed to in their lifetime), we discover that their symptoms, emotions and behavioral responses are actually rooted in unprocessed traumas, which can have negative effects on a person’s mental, emotional, physical, relational and interpersonal aspects of life.
Though not an exhaustive list, here are a few examples:
- Mental/Emotional: worry, fear, anxious, depressed, panic, sleep disturbance, catastrophizing (worst case scenario), suicidal thoughts, hopelessness, irritability, anger, despair, intrusive thoughts, flashbacks, etc.
- Physical: Chronic muscle tension, pain, migraines, chronic GI dysfunction, vomiting, acid reflux, jaw clenching, tension in temples/head.
- Behavioral: violence, aggression, anger outbursts, impulsivity, reckless behavior, abusive
- Relational: social withdrawal or isolation, avoidance of large crowds, disassociation
- Professional/Educational: avoiding or showing up chronically late to work or class, lack of care for consequences, difficulty concentrating, difficulty remembering, not turning in work, missing deadlines, failing tests, suspensions, academic probation
- Self-medicating behaviors: increase or excessive use of alcohol and/or drugs, addictive tendencies: sexual, physical, behavioral (over-working, over-functioning); self-harm including cutting, suicidal ideation or attempts; head banging, eating disorders, excessive exercise, avoiding sleep
It is important that we identify what we are experiencing and what we have experienced to determine if PTSD is an appropriate diagnosis and more, importantly, to establish the best plan of care to treat it.
How Do You Know If You Have Been Exposed to a Traumatic Event?
Most people will have exposure to a traumatic event in their lifetime; however, that does not imply that everyone will develop symptoms that meet the criteria for PTSD. And, if you do develop symptoms of PTSD, that does not mean that you are weak, in any way. It’s simply how your brain and body have responded.
“According to the National Center for PTSD , a program of the U.S. Department of Veterans Affairs, about six out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men. Certain aspects of the traumatic event and some biological factors (such as genes) may make some people more likely to develop PTSD.”
Here’s the great news: you don’t have to continue living in a state of fear or panic. There are several effective therapies to help you overcome your post traumatic response.
Therapies for PTSD:
- Eye Movement Desensitization and Reprocessing (EMDR)
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
- Cognitive Processing Therapy (CPT)
- Prolonged Exposure (PE)
For more information about PTSD, please visit here.
References:
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
- American Psychiatric Association. (2023). Diagnostic and Statistical Manual of Mental Disorders, Text Revision Dsm-5-TR 5th Edition.
- Ho JMC, Chan ASW, Luk CY, Tang PMK. Book Review: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Front Psychol. 2021 Aug 18; 12:704974. doi: 10.3389/fpsyg.2021.704974. PMCID: PMC8418154.
- National Center for PTSD. (n.d.). VA.gov | Veterans Affairs. https://www.ptsd.va.gov/
- Post-Traumatic Stress Disorder. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
- Van der Kolk, B. A. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. New York, New York, Penguin Books.
